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Surgical Resection Versus Laparoscopic Radiofrequency Ablation in Patients With Hepatocellular Carcinoma and Child-Pugh Class A Liver Cirrhosis

  • Hepatobiliary and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis.

Methods

We enrolled 152 cirrhotic patients out of 372 cases consecutively evaluated for HCC. Enrolled patients with similar baseline characteristics underwent HR (n = 78) or LRFA (n = 74), in both cases with intraoperative ultrasonography, and they were then followed for similar durations (mean ± standard deviation, 36.2 ± 23.5 months for HR vs. 38.2 ± 28.4 for LRFA). Outcomes included short- and long-term morbidity, HCC recurrence, and overall survival.

Results

Short-term morbidity was far higher in the HR group while, during follow-up, HCC recurrence (mainly local) was more frequent in patients treated with LRFA. More importantly, baseline alfa-fetoprotein levels and early HCC recurrence after treatment greatly influenced overall survival, while the use of HR or LRFA did not predict it. On the other hand, HCC recurrence was found to be determined by the surgical approach and ultrasound characteristics of the tumor.

Conclusions

Our data were obtained from a large number of HCC cases and support similar survival rates after HR or LRFA for single HCC nodules on Child-Pugh class A liver cirrhosis, despite a marked increase in HCC recurrence rates after LRFA.

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Authors and Affiliations

  1. USD di Chirurgia Epato-bilio-pancreatica, Ospedale Classificato San Giuseppe, Milanocuore SpA, Milan, Italy

    Roberto Santambrogio MD & Matteo Conti MD

  2. UO Chirurgia 2, Azienda Ospedaliera San Paolo, Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano, Milan, Italy

    Enrico Opocher MD & Mara Costa MD

  3. Cattedra di Medicina Interna, Azienda Ospedaliera San Paolo, Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano, Milan, Italy

    Massimo Zuin MD & Emanuela Bertolini MD

  4. Dipartimento di Medicina Interna, IRCCS-Istituto Clinico Humanitas, Università degli Studi di Milano, Rozzano, Milan, Italy

    Carlo Selmi MD, PhD

  5. Cattedra di Chirurgia Generale, IRCCS-Istituto Clinico Humanitas, Università degli Studi di Milano, Rozzano, Milan, Italy

    Marco Montorsi MD

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  1. Roberto Santambrogio MD
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Correspondence to Roberto Santambrogio MD.

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Santambrogio, R., Opocher, E., Zuin, M. et al. Surgical Resection Versus Laparoscopic Radiofrequency Ablation in Patients With Hepatocellular Carcinoma and Child-Pugh Class A Liver Cirrhosis. Ann Surg Oncol 16, 3289–3298 (2009). https://doi.org/10.1245/s10434-009-0678-z

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  • DOI: https://doi.org/10.1245/s10434-009-0678-z

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